Provider Demographics
NPI:1770071227
Name:MCCALLA, SELENA DELLE (APN)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:DELLE
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5657
Mailing Address - Country:US
Mailing Address - Phone:217-554-1700
Mailing Address - Fax:217-554-1704
Practice Address - Street 1:516 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5657
Practice Address - Country:US
Practice Address - Phone:217-554-1700
Practice Address - Fax:217-554-1704
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily